Feasibility of standard mechanical ventilation with low FiO<sub>2</sub> and small endotracheal tubes during laser microlaryngeal surgery

Nicelli, Elisa; Gemma, Marco; Vitis, Assunta De; Beretta, Luigi

doi:10.1002/hed.21168

Cited by 6 publications

(9 citation statements)

References 26 publications

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“…The best results of variables in post-anesthetic care, postoperative pain assessment and the lower incidence and severity of complications among patients in group E are comparable to the results of monographs published by other authors [3,5,9,13].…”

Section: Discussionsupporting

confidence: 85%

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Safety and Effectiveness of Jet Ventilation with Conventional Ventilatory Frequencies for Elective Microlaryngeal Surgery

Llanes¹

2020

JCRR

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Introduction: Ventilate patients during microlaryngeal surgery confronts several problems. Jet ventilation with conventional ventilatory frequencies allows the use of small diameter endotracheal catheters to provide adequate oxygen volumes and better operating conditions than the traditional method. Objective: Evaluate the safety and effectiveness of jet ventilation with conventional ventilatory frequencies for elective microlaryngeal surgery. Methods: A comparative, single-blind, randomized and parallel study was performed. It was used a prototype of jet ventilation device (with an exceptional use permit in humans conferred by the Center for the State Control of Medication, Dispositive and Medical Equipment) in a study group of 45 patients (group E) and compared with a control group (group C) of 15 patients using the traditional ventilation method. Results: Oxygenation was higher in group E. Group C eventually required extubation, transitory apnea and reintubation, which impacted against the anatomophysiological integrity of patients, the operative field and teaching. A greater hemodynamic stability was evident among the subjects of group E. The intrapulmonary pressures produced by jet ventilation did not cause obvious injuries or clinical repercussions. Conclusions: Applying jet ventilation with conventional ventilatory frequencies was safe and effective. For the first time, experiences of using a jet ventilation method in the country were obtained. The group in which traditional ventilation method was applied suffered more frequent and dangerous complications. It is necessary to assimilate jet ventilation´s technologies to raise the quality of medical attention in times of peace, war or disasters, in elective or emerging contexts as the challenge of a difficult airway.

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Section: Discussionsupporting

confidence: 85%

“…Probably this also influenced the statistically significant decrease in oxygenation in group C. Several authors agree on reports of better results in the oxygenation variables analyzed, when comparing different techniques of jet ventilation with other ventilatory modes [3][4][5]10,17].…”

Section: Discussionsupporting

confidence: 61%

Safety and Effectiveness of Jet Ventilation with Conventional Ventilatory Frequencies for Elective Microlaryngeal Surgery

Llanes¹

2020

JCRR

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“…The response of pulmonary vasculature to hyperoxia however is not known and therefore a 100% Fi0 2 could have changed the pulmonary artery pressure during the execution of the CT scans. During invasive pulmonary arterial pressure measurements, interventional cardiology procedures, or laser microlaryngeal surgery, human patients and especially pediatric patients are usually ventilated with ambient air (FiO 2 , 21%) (51)(52)(53). A high oxygen concentration is commonly used in pediatric patient to reduce pulmonary vascular resistance in conjunction with inhaled nitric oxide, when investigating pulmonary hypertension (51).…”

Section: Discussionmentioning

confidence: 99%

Utility of Computed Tomographic Angiography for Pulmonary Hypertension Assessment in a Cohort of West Highland White Terriers With or Without Canine Idiopathic Pulmonary Fibrosis

Soliveres

Entee

Couvreur³

et al. 2021

Front. Vet. Sci.

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West Highland white terriers (WHWTs) affected with canine idiopathic pulmonary fibrosis (CIPF) are at risk of developing precapillary pulmonary hypertension (PH). In humans, thoracic computed tomography angiography (CTA) is commonly used to diagnose and monitor patients with lower airway diseases. In such patients, CTA helps to identify comorbidities, such as PH, that could negatively impact prognosis. Diameter of the pulmonary trunk (PT), pulmonary trunk-to-aorta ratio (PT/Ao), and right ventricle-to-left ventricle ratio (RV/LV) are CTA parameters commonly used to assess the presence of PH. Pulmonary vein-to-right pulmonary artery ratio (PV/PA) is a new echocardiographic parameter that can be used in dogs to diagnose PH. The primary aim of this study was to evaluate the use of various CTA parameters to diagnose PH. An additional aim was to evaluate the correlation of RV/LV measurements between different CTA planes. CTA and echocardiography were prospectively performed on a total of 47 WHWTs; 22 affected with CIPF and 25 presumed healthy control dogs. Dogs were considered to have PH if pulmonary vein-to-right pulmonary artery ratio (PV/PA) measured on 2D-mode echocardiography was less than to 0.7. WHWTs affected with CIPF had higher PT/Ao compared with control patients. In WHWTs affected with CIPF, PT size was larger in dogs with PH (15.4 mm) compared with dogs without PH (13 mm, p = 0.003). A cutoff value of 13.8 mm predicted PH in WHWTs affected with CIPF with a sensitivity of 90% and a specificity of 87% (AUC = 0.93). High correlations were observed between the different CTA planes of RV/LV. Results suggest that diameter of the PT measured by CTA can be used to diagnose PH in WHWTs with CIPF.

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“…Even then, despite a consistent trend toward progressive hypercapnia and respiratory acidosis, the pH and EtCO2 values remain within physiologic range. 8,9 With most glottic pathology originating in the anterior two thirds of the larynx, consistent positioning of a small MLT tube between the arytenoid cartilages in the posterior part of the glottis leaves most of the surgical field unobstructed to the surgical view and manipulations. Even with many posterior glottic disorders, it may be possible for the surgeon movable, metal jet cannula can be passed through the glottis by the surgeon after the suspension laryngoscope is in position.…”

Section: Endotracheal Intubation With Microlaryngeal Tracheal Tubesmentioning

confidence: 99%

Airway management for microlaryngeal surgery

Marinov

Belitova

Popov³

et al. 2020

International Bulletin of Otorhinolaryngology

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Theoretical basis: Microlaryngeal surgery can be conducted in an awake patient, frequently under conscious sedation, or with the patient anesthetized. The ventilation options under general anesthesia consist of "tube" (i.e., endotracheal intubation) and "tubeless" techniques, with the latter represented by the techniques of Spontaneous ventilation, Apneic intermittent ventilation (AIV), and Jet Ventilation (JV). Results: The use of a small (5.0-mm ID) MLT tube with positive-pressure ventilation remains the standard for airway management in most nonlaser microlaryngeal surgery, and it is associated with minimal or no intraoperative complications. Spontaneous ventilation is rarely used in adult microlaryngeal surgery, but it is commonly employed in the pediatric patient population. AIV remains a relatively popular technique for microlaryngeal surgical procedures of short duration in some surgical centers. Superimposed High-Frequency Jet Ventilation (SHFJV), which combines highfrequency and low-frequency ventilation modes, has been used effectively in surgical treatment of high-grade laryngeal and tracheal stenosis. Conclusion: General anesthesia for microlaryngeal surgery represents a unique example of close cooperation between the surgeon and the anesthesiologist.

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Feasibility of standard mechanical ventilation with low FiO₂ and small endotracheal tubes during laser microlaryngeal surgery

Abstract: Standard mechanical ventilation with FiO2 = 0.21 through laser-safe ETTs is feasible during direct microlaryngoscopy.

Cited by 6 publications

References 26 publications

Safety and Effectiveness of Jet Ventilation with Conventional Ventilatory Frequencies for Elective Microlaryngeal Surgery

Safety and Effectiveness of Jet Ventilation with Conventional Ventilatory Frequencies for Elective Microlaryngeal Surgery

Utility of Computed Tomographic Angiography for Pulmonary Hypertension Assessment in a Cohort of West Highland White Terriers With or Without Canine Idiopathic Pulmonary Fibrosis

Airway management for microlaryngeal surgery

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Feasibility of standard mechanical ventilation with low FiO2 and small endotracheal tubes during laser microlaryngeal surgery

Abstract: Standard mechanical ventilation with FiO2 = 0.21 through laser-safe ETTs is feasible during direct microlaryngoscopy.

Cited by 6 publications

References 26 publications

Safety and Effectiveness of Jet Ventilation with Conventional Ventilatory Frequencies for Elective Microlaryngeal Surgery

Safety and Effectiveness of Jet Ventilation with Conventional Ventilatory Frequencies for Elective Microlaryngeal Surgery

Utility of Computed Tomographic Angiography for Pulmonary Hypertension Assessment in a Cohort of West Highland White Terriers With or Without Canine Idiopathic Pulmonary Fibrosis

Airway management for microlaryngeal surgery

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Feasibility of standard mechanical ventilation with low FiO₂ and small endotracheal tubes during laser microlaryngeal surgery